Effect of nebulized formoterol, ipratropium bromide, and furosemide in combination with fluticasone propionate on arterial blood gases of premature calves with respiratory distress syndrome

Abstract

The purpose of this study was to assess the clinical effect of nebulized formoterol (FM), ipratropium bromide (IB) and furosemide (FS) combined with fluticasone propionate (FP) on l ung function in premature calves with Respiratory Distress Syndrome (RDS). Thirty-six premature calves with RDS were randomly assigned to six different treatment groups (D1 to D6). All groups received the standard treatment, including oxygen and support treatment. Calves in D1 received only the standard treatment. The following combinations of nebulized drugs were used for the other groups: D2: FP, D3: FP+FM; D4: FP+IB; D5: FP+FS and D6: FP+IB+FM+FS. The treatment period (72 h) involved the application of FM (15 μg totally/12 h), IB (2 μg/kg/12 h), FS (1 mg/kg/12 h) and FP (15 μg/kg/12 h) for five minutes. A significant increase over time in blood pH, partial pressure of oxygen (PaO2), oxygen saturation (SatO2) and a decrease in partial pressure of carbon dioxide (PaCO2) and lactate were detected in all groups that received nebulized treatment; while in the D1, a significant change was observed only for PaCO2. Calves in D6 had the highest PaO2 and lowest PaCO2 values amongst all groups at the end of treatment. No statistical difference was observed between the Nebulization Groups (NG). Nebulized FM, IB and FS with FP combination in premature calves with RDS, in addition to the standard treatment showed a significant curative effect on lung function.

Biomarkers in premature calves with and without respiratory distress syndrome

“…According to clinical observations and blood gas analysis, premature calves that met the criteria for RDS were enrolled in the trial group, premature calves without RDS were enrolled in the positive control group, and healthy normal‐term calves were enrolled in the negative control group. The criteria for prematurity were decreased gestation period (<255 days), low body weight (BW), a short silky hair coat, incomplete eruption of incisors, soft hooves, and weak or no suckling reflex 7,8,27 …”

“…Hypoxia (PaO 2 < 60 mm Hg), hypercapnia (PaCO 2 > 45 mm Hg), tachypnea (breaths per minute >45/min), and abdominal respiration with wheezing were the criteria for distinguishing between calves with or without RDS 7,8,27,28 . A PaO 2 <60 mm Hg and at least 2 other criteria described above were required for a case to be diagnosed as RDS.…”

“…After 3 hours, the oxygen flow rate was decreased to 3 to 4 L/min. Oxygen treatment was continued until SO 2 reached 80% 7,8 …”

“…The nebulization form of fluticasone (fluticasone propionate, Flixotide, GlaxoSmithKline, Istanbul, Turkey) was diluted with 2.5 mL saline solution and administered at a dosage of 15 μg/kg BW over 5 minutes by nebulization for 3 days with 12 hours between treatments 7,8 . The nebulization form of formoterol (Foradil, Novartis, Ankara, Turkey) was diluted with 2.5 mL saline solution and administered at a dosage of 12 μg/kg BW over 5 minutes by nebulization for 3 days with 12 hours between treatments 8 . The parenteral form of furosemide (Desal, Munir Sahin İlac, Istanbul, Turkey) was diluted with 2.5 mL saline solution and administered at a dosage of 1 mg/kg BW over 5 minutes by nebulization for 3 days with 12 hours between treatments 7,8 …”

“…Premature birth remains an important and common cause of calf mortality in the world 1‐4 . The most important problems in premature infants is respiratory distress syndrome (RDS) that leads to increased respiratory effort and inadequate oxygen exchange 5‐8 . The RDS caused by surfactant insufficiency is associated with pulmonary hypertension (PHT) in lambs 9 .…”